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PubMed2000

The reality of mammography utilization in the state of Arkansas.

The Arkansas Mammography Data Collection Project, funded by the Arkansas Department of Health, aimed to determine the mammography screening patterns throughout the state of Arkansas. Data were obtained from 92 mammoraphy centers out of 112 centers (82%). A total of 157,976 mammography data sets were obtained for 148,586 women. Mammography rate was 22.7% for women 40 years and older and 24.1% for women 50 years and older. Mammography rates per county varied from 0.3% to 42.6%. The overall low rate of mammography utilization reflects the need to intensify public health interventions and continuous evaluations of these interventions.

Adult↗

PubMed2003

Screening mammography in the elderly: a review of the issues.

Women age 70 and older have the highest incidence and mortality from breast cancer of any age group. Despite this increased burden of disease, studies show that older women are the least likely to be screened for breast cancer. Barriers to routine mammography in this population include transportation and logistical issues, psychosocial barriers, low literacy levels, and institutional barriers. A variety of interventions, such as community health educators and mobile mammography, have been effective at increasing screening mammography among older women. Although limited, studies have reported that screening mammography reduced breast cancer mortality among women age 65 and older. Research supports continued screening with mammography for elderly women as long as their health is not significantly compromised by comorbid illness, and most organizational guidelines support screening mammography in healthy elderly women. Ultimately, the decision to continue breast cancer screening should be made by the patient and her physician after carefully weighing the risks and benefits of the procedure, which generally become more favorable as women age.

Aged↗

PubMed1992

[Radiologic types in mammography in the 90-s. New classification].

The Authors present a critical review of the classification of radiological types in mammography proposed in 1986. On the basis of their personal experience over the past years, and in the light of the changed indications given by screening the asymptomatic population, a series of 6,072 mammographies performed over a 12-month period were included in the study. These were non-selected cases undergoing X-ray examination for a variety of reasons, ranging from periodical control to carcinophobia. No clinical or epidemiological data were taken into account in order to limit analysis to radiological factors alone. The analysis of results allows a few comments to be made and suggests an interpretation which differs from that in vogue in the 80s. First of all, the steady rise in mammographic controls calls for an uniformity of technique with interchanges of information between the various centres of breast cancer in order to encourage increasingly accurate diagnostic evaluations. The higher incidence of the trabecular type (33.7%), typical of women in their 40s, underlines the greater diffusion of mammography which now starts at an increasingly early age. Current control programmes (in spite of some recent controversy) include 40-year-old women who undergo basic mammography in spite of the absence of symptoms. On the other hand, the irreplaceable diagnostic value of mammography during the asymptomatic years is now widely recognised, even in those women who undergo a regular clinical examination. The fibroadipose type has dropped to second place (26.8%) not due to a reduction in the number of these cases, but rather on account of the lower age at which women first undergo mammography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

[Motivation to participate in mammography screening program for breast cancer].

The rates of incidence and mortality of breast cancer in Lithuania are increasing. The causal prophylaxis is unknown. The early mammography diagnosis improves results of treatment. The aim of the study is to investigate the motivation to participate in mammography screening program for breast cancer and to evaluate the relationship between these motives and women age, education, family history, personal income. Two hundred three women were interviewed about the motivation to participate in mammography screening program for breast cancer. The strength of motivation was estimated in parametric variable. It was attempted at evaluating the influence of age, education, family history and personal income on the level of motivation. Logistic analysis was used. Asymptotic women participated in mammography screening program for breast cancer. Complaints about their breasts as a motive to participate indicated only 31.8% of all women. After the survey it was observed that women understand the danger of breast cancer (86.1%) and believe that early diagnosis can protect from the poor outcome of the disease. Out of interviewed women, 85.3% (independently from their income, age, education and family history) think that it is essential for every woman to participate in mammography screening program for breast cancer. The majority of all surveyed women were informed about the program by their doctors. This motive became the main one to consult about breast cancer for 63% of women. The mass media made no significant impact to participate in mammography screening program for breast cancer.

Adult↗

PubMed1992

Compliance with guidelines for mammography screening.

The health belief model was used to identify potential variables related to intention or compliance with mammography guidelines. Scales to measure independent and dependent variables were developed from previous research and assessed for validity and reliability. A probability sample of women 35 and older (x = 50) who resided in a large metropolitan area and surrounding counties (n = 322) participated in in-home interviews. Intent to complete mammography was related to having a family history of breast cancer, perceived barriers to mammography, and perceived control over breast cancer. Compliance with mammography was influenced by general health motivation and perceived susceptibility to and seriousness of breast cancer, benefits, and control over breast cancer. In addition, knowledge about breast cancer and breast cancer detection, age, having a health care provider suggest mammography, having symptoms of breast cancer, and socioeconomic status were significantly related to actual compliance with mammography.

Adult↗

PubMedDate not supplied

Individual and regional determinants of mammography uptake.

BACKGROUND: Analysis of mammography utilization has traditionally been performed from an individual-level perspective. The purpose of this study was to explore the combined influence of individual- and regional-level determinants of mammography utilization. METHODS: Logistic hierarchical multilevel modelling was used to investigate the influences of region of residence and individual characteristics on mammography utilization. Socioeconomic status information about health planning regions was derived from the 1996 Canadian Census. Individual-level information was extracted from the 1996 National Population Health Survey. RESULTS: After controlling for individual-level education, regions with fewer high school graduates had lower levels of mammography utilization. A cross-level interaction between regional-level education and individual-level social involvement was found. Other individual-level variables associated with screening confirmed previous literature findings. CONCLUSION: Our findings suggest that higher levels of participation in social activities modify the detrimental influence on mammography utilization of living in a less educated region. This challenges the current focus of mammography screening research on individual-level determinants of uptake. Multilevel, synergistic strategies to possibly achieve higher levels of screening should be considered by health promotion program planners.

Aged↗

PubMed2005

Empowering factors for regular mammography screening in under-served populations: pilot survey results in Tennessee.

BACKGROUND: Mammography screening can reduce breast cancer burden, however it continues to be underutilized by low-income women even though their health insurance provides free mammograms. While a vast majority of eligible women in Tennessee do not receive the free mammograms available to them, 25% of women with comparable backgrounds do. OBJECTIVE: To describe the influences that may have led these women to adhere to mammography screening guidelines in order to develop a case-control study for further research. DESIGN: Healthcare workers conducted personal interviews on mammography knowledge, attitudes, and behaviors. SETTING: In-home. PARTICIPANTS: All were members of the Managed Care Organization Access MedPlus with incomes <200% above poverty. All were adherent to mammography guidelines per medical records. Fifty-eight respondents were Black, 27 were White, and all were at least 40 years old. RESULTS: Participants recognized breast cancer risk factors, warning signs, and the importance of early detection to survival. 75% reported a family history of any cancer type, 77% knew someone who had breast cancer, and 52% knew someone who had died from it. These women expressed that screening strongly reassured them. Willing to work with their doctors, they trust the health system's ability to treat breast cancer and are generally satisfied with their health care. CONCLUSIONS: Repeat regular mammography screening is positively associated with higher knowledge about risk factors, warning signs, screening, and treatment. Trust in the healthcare system, ability to work with physicians, and support by family and friends lead low-income, adhering women to be proactive in seeking mammography screenings.

Adult↗

PubMed1992

The supply of mammography resources in West Virginia.

The distribution of mammography machines and related resources in West Virginia, along with the distribution of breast cancer screen-eligible women, are examined using county-specific data. This data placed on a state map shows that it is not necessary to cross more than one county line anywhere within West Virginia in order to visit a mammography facility. The overall density of these machines is 20 per 100,000 women over 45, almost double the capacity needed for screening mammography. After taking into account the projected demand for mammography, the current average cost per exam is around $65-$100. If mammography machines were placed in all the counties without machines, the cost in those countries would be around $140 per exam. It would be cheaper to provide a travel allowance to women in rural counties than to install machines in these areas. Machines that are accredited by the American College of Radiologists, the most available indicator of quality mammography, are located only in densely populated areas of the state.

Accreditation↗

PubMed1992

Diagnostic accuracy of lightscanning and mammography in women with dense breasts.

The diagnostic accuracy of lightscanning and mammography in 610 breasts with mammographically dense parenchymal patterns was investigated. Lightscanning identified 31 out of 36 cancers and mammography 32. Lightscanning and mammography were in agreement in 28 cases of cancer. One noninvasive lobular carcinoma was not identified by either modality. Four cancers were not correctly identified with lightscanning alone and 3 cancers with mammography alone. Of the 574 breasts without cancer, lightscanning falsely denoted 101 (18%) as possibly being cancerous (false-positives). The corresponding figure for mammography was 25 (4%). Thus, lightscanning, as performed in this study, has the same sensitivity as mammography in detecting cancer in mammographically dense breasts. However, its usefulness is limited by a low predictive value of a positive test (high rate of false-positives).

Adolescent↗

PubMed1992

New and future developments in screen-film mammography equipment and techniques.

Two improvements in mammography equipment during the last 4 years will greatly affect the practice of mammography during the next decade: dose reduction and improved testing equipment for monitoring the quality of mammography. The increased use of digital radiography has stimulated studies comparing digital mammography with screen-film mammography. Some digital algorithms for detecting clusters of calcifications may have application in screening mammography within the next decade.

Female↗

PubMed1991

Feasibility of universal screening mammography. Lessons from a community intervention.

It is estimated that 44,500 American women will die of breast cancer in 1991. The breast cancer screening guidelines of the American Cancer Society and the National Cancer Institute calling for annual mammography for all women older than 50 years have been endorsed by numerous professional groups. Third-party reimbursement for screening mammography is becoming more prevalent, and payment for screening mammography is now a Medicare benefit. Our studies, conducted as part of a National Cancer Institute grant to increase the routine use of screening mammography and clinical breast examination in women 50 to 75 years of age, have uncovered a number of significant barriers to the implementation of screening guidelines among women, primary care physicians, and providers of mammography services. These barriers, as well as methods to assure the quality of mammography, need to be addressed before universal screening is feasible.

Aged↗

PubMedDate not supplied

Evaluating women's attitudes and perceptions in developing mammography promotion messages.

Breast cancer is a leading cause of cancer deaths in women. Although mammography is recognized as the most effective early detection method for breast cancer, it remains underutilized. Communications theory and practice, with its emphasis on formative research, can provide a basis for developing strategies effective in changing mammography-related behaviors. Formative research, an important component of communications planning, can offer information useful in developing suitable messages and materials. The National Cancer Institute conducted small group discussions with white and black women, ages 40 to 75, to explore their attitudes, knowledge, and beliefs about mammography. Findings reinforced the results from quantitative surveys indicating that a perceived lack of their own need for the examination, lack of a physician referral, and procrastination were the main reasons that the women reported for not having mammograms. The discussions provided detailed information about the factors that can be used to guide development of messages and materials to promote mammography use. The results indicate that strategies for messages directed to either black or white women ages 40 years and older need to stress the same key message points. The points are that all women ages 40 and older are at risk for breast cancer; breast cancer can be treated successfully if it is detected early enough; mammography can detect breast cancer before a lump can be felt by a woman or her physician; women need to follow screening guidelines for age and frequency for screening; and mammography is a low-risk, quick, and painless procedure. Communication channels to reach women should include television, newspapers, magazines, and information available in physicians' offices.

Adult↗

PubMed1989

Mammography in symptomatic and asymptomatic patients.

It is now generally accepted that screening mammography at 1- to 3-year intervals can decrease mortality from breast cancer. Three randomized trials, involving a total of 238,000 women, have reported mortality results. In two trials (HIP and S2C), there was a significant reduction in breast cancer mortality (22 per cent at 18 years and 27 per cent at 8 years). One trial (Mälmo) showed a nonsignificant reduction in mortality at year 9 (5 per cent) and nonsignificant increases in mortality at earlier years. There are little data from randomized trials to support a benefit of mammographic screening in women under 50 years old. The two Swedish studies at last follow-up had 26 and 29 per cent more breast cancer deaths in young women in the group randomized to screening. The HIP study had 25 per cent fewer breast cancer deaths at 18 years in women under age 50 at the start of the trial, but because only 12 patients under age 50 had mammographically detectable tumors (out of 89 cancers diagnosed in the screened group), most of the benefit must be due to physical examinations or increased awareness of breast cancer symptoms. The as yet unpublished results of the Canadian trial in women under age 50 should elucidate the benefit of mammography in this age group. American centers report a malignant biopsy rate of 20 to 30 per cent for clinically occult lesions. This rate should increase as the proportion of women who have had prior mammography increases. High-quality mammography, including magnification technique for evaluation of suspicious lesions, proper localization and excisional biopsy techniques with pathologic correlation, and potentially, fine-needle aspiration, may improve the yield of screening mammography-induced open-biopsy procedures. Magnification technique can improve mammographic assessment of the extent of the tumor and guide re-excision for patients being considered for breast-conserving therapy. In the irradiated breast, in our experience, mammography alone detected 35 per cent of recurrent cancers in the irradiated breast. We recommend routine mammographic follow-up of the irradiated breast, including magnification of the local excision site, at 6 months, 1 year, and annually thereafter.

Adult↗

PubMed1987

The control of breast cancer through mammography screening. What is the evidence?

There are few forms of cancer that can be effectively controlled. Now that there is sufficient evidence demonstrating that mortality from breast cancer can be reduced with the help of mammography screening, we are faced with the challenge of applying this method on a large scale. What are the major practical problems? The medical profession and decision makers must be made familiar with nature of the recent achievements and with their practical implications. The personnel who will be responsible for undertaking screening have to be adequately trained before screening gets under way. Women should understand the benefits that they can gain from mammography screening so that they will be sufficiently motivated to attend. This can be achieved by sincere, periodic information through the mass media. It is important that every woman eligible for screening understand that her risk of dying from breast cancer will be half as much if she participates in screening as it would be if she fails to participate. She should also be aware that the smaller cancers detected at screening can often be removed by breast conserving surgery without the need for mastectomy. Because mammography does not prevent breast cancer, women must be aware of the fact that mammography has to be repeated at regular intervals if the benefits of screening are to be maintained. Additionally, breast self-examination should be practiced in the interval between screens. Finally, decision makers will have to realize that screening with mammography can, in the long run, lead to reduction of health service costs. It is obvious that the expenses involved in taking care of a patient with advanced breast carcinoma can be very high. As it has been clearly demonstrated that properly performed screening will significantly decrease the number of advanced, costly breast carcinomas, a large proportion of these expenses will be saved in the population invited to screening. Because screening itself drains economic resources, the costs of screening outweigh the savings until the number of advanced cancers decreases; however, after this occurs the expenses of screening will be far less than the savings. The savings arise from the smaller number of advanced, costly cases. The results to date are convincing enough to justify recommending large-scale mammographic screening. The Swedish government has recommended screening with mammography for all women aged 40-74. This recommendation repeatedly emphasizes the necessity of high quality examinations interpreted by well-trained radiologists.

Breast Neoplasms↗

PubMed1987

Factors influencing women's decision to undergo mammography.

Despite the consensus that mammography is a valuable screening tool for the detection of early breast cancer, it is underused by physicians, and most women remain unconvinced of its efficacy. We studied consecutively 735 women who underwent mammography at two rural midwestern hospitals to determine the factors that influence the decision to undergo mammography. Those who underwent mammography had significantly more education and higher household incomes than the general population. The decision to have mammography was influenced by many factors, the most important of which were encouragement by the doctor, influence of the media, and the cost of the mammogram. Women of higher socioeconomic status were most likely to be influenced by the media, particularly printed material, but were much less likely than women of lower socioeconomic status to report physician influence as an important factor. These data have implications for the methods physicians use in recommending mammography to individual patients.

Adult↗

PubMed1986

[The dangers of mammography in diagnosing a palpable lump in the breast].

The success of mammography screening programmes in the detection of unsuspected and impalpable breast cancer has led to reliance on a negative mammographic report as assurance that no malignancy is present even in palpable breast lumps. Pre-operative mammography was performed on 38 patients with palpable lumps who were subsequently proven by histology to have carcinoma of the breast. In 4 patients (10.8%) the mammogram was negative; 3 were also assessed as benign clinically. In 5 cases (13.5%) the report was negative but biopsy was recommended; 3 of the 5 were assessed as benign clinically. Therefore, in 9 of the 38 patients (24%) malignancy was not diagnosed unequivocally on mammography, although 3 of these patients had clinical stigmata of malignancy. Twenty-nine patients (76%) were diagnosed correctly by mammography; 5 of these cases were assessed as benign clinically. Six of the 38 cases (16%) were thought to be benign on both mammography and clinical examination. Thus, even confirmation by mammography that a breast lump without clinical signs of malignancy is indeed benign, does not rule out the possibility of carcinoma.

Breast Neoplasms↗

PubMed1979

Indications and risk-benefit of mammography.

Mammography has recently undergone a striking improvement in image detail along with a corresponding decrease in radiation exposure. Although the data of the Breast Cancer Detection Demonstration Project is tainted by an absence of a control group of women, the high rate of detection of early cancer by mammography alone in the participants above or below age 50 years implies that mammography is useful in detecting breast cancer before the appearance of a palpable mass. Early diagnosis results in higher survival rates. Mammographers should continuously seek the least radiation exposure consistent with a sharp image. Given present knowledge of its benefit and potential risk, mammography should be performed when a significant suspicion of breast cancer exists at any age, but it should not be performed under age 35 years without such suspicion. A baseline mammogram should be performed in the 35 to 40-year age group. The periodicity of survey mammography in asymptomatic women under 50 years should be determined by analysis of relative risk factors for breast cancer. For asymptomatic women age 50 years and older, periodic screening mammography is sound medical practice.

Adult↗

PubMed1983

Family physicians' beliefs about breast cancer screening by mammography.

A survey of 509 family physicians in New York State was conducted to assess opinions about mammography and use of mammography in screening asymptomatic women of different ages. Findings indicate that most family physicians believe that mammography is an effective procedure for detecting breast cancer in its early stages, but many do not utilize mammography as a screening procedure in their own practices. The major deterrents to the use of mammography in screening asymptomatic women relate to concerns about the safety and reliability of the procedure, the low probability of detecting breast cancer through screening, the patient's willingness to accept a recommendation to have a mammogram, and cost. The results from this study point out the need to better educate primary care physicians about the use of mammography in screening for breast cancer, especially in regard to its safety and reliability.

Adult↗